“We didn’t ask. We just forced it.” Estonian e-government pioneer says there is no innovation without pain

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A key figure behind Estonia’s transition into the world’s first ‘e-government’ system at the turn of the century has defended some of the controversial decisions made to enable the transformation.

Taavi Kotka, the Baltic state’s former chief information officer, told HIMSS UK e-Health Week delegates that in order to provide as many public services online as possible, painful political decisions needed to be taken.

To create a system in which citizens would carry out the vast majority of their interactions with the government online, it was necessary to issue mandatory ID cards, Kotka explained.

“Estonians are very rational people. We didn’t ask [if they wanted ID cards]. We just forced it. Innovation through pain has always been a key element of change. If the engineers say you have to do it this way – it's not a question for debate.

“Innovation won't happen if you don't force it. Everybody has a unique identity card,” said Kotka.

He added that in exchange for government requirements that every citizen hold a unique national ID, strong privacy guards were put in place, particularly for health records.

“To protect privacy we have a system that allows people to see who viewed their data – a logbook. If I find a name that I don’t recognise I can run a query and if the person has no good reasons to search [my] data then they will be instantly dismissed. If you pass data to a third party you will go to jail,” Kotka explained.

He added that while 90 per cent of patients in Estonia have never logged into their online patient portal, it is enough for them to know this choice is open to them.

Kotka said that when government services began the process of digitisation, different parts of the public sector were permitted to make their own choices about which software platforms to use.

“The Estonian system was built in such a way that everybody takes care of their own stuff. I as government CIO can’t tell people what software to use. But you have to create application programme interfaces (APIs), so others can connect with you.”

Originally published on the British Journal of Healthcare Computing, a sister publication of HITNA.